Kussmaul Sign in Constriction — EECC MCQ

Correct answer: C — Kussmaul sign — paradoxical rise in JVP during inspiration; in constrictive pericarditis, the rigid pericardium prevents the RV from expanding to accommodate the increased venous return during inspiration, causing RA pressure to rise; it is a characteristic (but not pathognomonic) sign of constriction

Kussmaul sign (paradoxical inspiratory rise in JVP) is a hallmark of constrictive pericarditis, though not pathognomonic (can occur in RV infarction, restrictive cardiomyopathy, severe RV failure, and massive PE). Normal physiology: inspiration generates negative intrathoracic pressure → increased venous return → RA accommodates the increased volume → JVP falls. In constriction: the rigid pericardium cannot expand → the RV cannot accommodate increased venous return → RA pressure rises → JVP rises paradoxically. Other constrictive pericarditis signs: prominent y descent (rapid early diastolic filling against the rigid pericardium), pericardial knock (high-pitched early diastolic sound from abrupt cessation of ventricular filling), hepatomegaly, ascites (often out of proportion to peripheral oedema), and low-voltage ECG. The 2025 ESC Pericarditis Guidelines include Kussmaul sign as a clinical diagnostic feature.

Reference: ESC (2025): Myocarditis/Pericarditis Guidelines